{"id":216748,"date":"2022-09-19T17:46:00","date_gmt":"2022-09-19T17:46:00","guid":{"rendered":"https:\/\/wandsworthphysiotherapy.co.uk\/what-is-infa-patella-fat-pad-impingement\/"},"modified":"2025-10-28T12:14:05","modified_gmt":"2025-10-28T12:14:05","slug":"infa-patella-fat-pad-impingement","status":"publish","type":"post","link":"https:\/\/wandsworthphysiotherapy.co.uk\/infa-patella-fat-pad-impingement\/","title":{"rendered":"What is infra-patella fat pad impingement?"},"content":{"rendered":"\n<h1 class=\"wp-block-heading\"><span style=\"color: #339966;\">What is the infra-patella fat pad?<\/span><\/h1>\n\n\n\n<p class=\"wp-block-paragraph\"><iframe title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/kjvqHFjXKMw\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">infra-patella fat pad impingement: The infra-patella fat pad (sometimes <a href=\"https:\/\/www.bupa.co.uk\/health-information\/knee-pain\/infrapatellar-fat-pad-syndrome\" data-type=\"link\" data-id=\"https:\/\/www.bupa.co.uk\/health-information\/knee-pain\/infrapatellar-fat-pad-syndrome\" target=\"_blank\" rel=\"noopener\">known as Hoffa\u2019s fat pad<\/a>) is inferior to the patella and deep to the patella tendon. It\u2019s intracapsular and attached to the joint line and menisci. The superior lateral fat pad is often impinged at the lateral joint line.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The exact role is not fully understood; however, it may add congruency to the joint. Some people have a rather large fat pad, others not so and some textbooks describe it as the most pain sensitive tissue in the body (I dread to think how they tested that!)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Most of the time the pain is caused by inflammation. It gets engorged with cytokines and fluid and becomes larger \u2013 thus can become compressed \/ irritated by the kneecap. The fat pad is the most innervated structure in the knee, and it is an incredibly irritable structure.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img fetchpriority=\"high\" decoding=\"async\" width=\"1024\" height=\"686\" src=\"https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2025\/02\/Wandsworth-Physio-403-1024x686.jpg\" alt=\"infra-patella fat pad impingement\" class=\"wp-image-216955\" srcset=\"https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2025\/02\/Wandsworth-Physio-403-1024x686.jpg 1024w, https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2025\/02\/Wandsworth-Physio-403-300x201.jpg 300w, https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2025\/02\/Wandsworth-Physio-403-768x515.jpg 768w, https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2025\/02\/Wandsworth-Physio-403-1536x1030.jpg 1536w, https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2025\/02\/Wandsworth-Physio-403-2048x1373.jpg 2048w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span style=\"color: #339966;\">How do we diagnose infra-patella fat pad impingement?<\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">It\u2019s very much a clinical diagnosis and has a fairly consistent set of symptoms.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>It\u2019s usually quite distinct with patient\u2019s able to point to the pain<\/li>\n\n\n\n<li>It\u2019s tender on palpation (Hoffa\u2019s sign)<\/li>\n\n\n\n<li>It\u2019s aggravated by prolonged standing and walking<\/li>\n\n\n\n<li>It\u2019s worse in near terminal extension and hyperextension<\/li>\n\n\n\n<li>It likes to stand in flexion<\/li>\n\n\n\n<li>Heels can relieve pain<\/li>\n\n\n\n<li>Flat shoes can aggravate it<\/li>\n\n\n\n<li>It\u2019s usually swollen \/ visual oedema<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">We can see the fat pad very clearly on ultrasound but we can\u2019t diagnose based on US features and an MRI would be required.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span style=\"color: #339966;\">What causes infra-patella fat pad impingement?<\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Post arthroscopy \u2013 the portal scars go through the fat pad<\/li>\n\n\n\n<li>Numerous or forceful direct blows to the fat pad<\/li>\n\n\n\n<li>Hyperextension injury or poor control of extension \/ proprioceptive control<\/li>\n\n\n\n<li>Patella instability<\/li>\n\n\n\n<li>Tight lateral structure \/ poor glute control leading to supero-lateral impingement<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span style=\"color: #339966;\">How do we treat infra-patella fat pad impingement?<\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span style=\"color: #339966;\">Stage 1 \u2013 settle the pain and get the inflammation down<\/span><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>No barefoot walking \/ flat shoes such as pump or Uggs \u2013 indoor shoes with a slight heel.<\/li>\n\n\n\n<li>Minimise aggravating activities \/ relative rest<\/li>\n\n\n\n<li>Ice massage \u2013 oil the skin and ice massage 3-5 mins at least once a day in the evenings<\/li>\n\n\n\n<li>Taping to offload with rigid tape or k-tape<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><span style=\"color: #339966;\">Stage 2 \u2013 reconditioning. This varies hugely \u2013 don\u2019t push into pain as the fat pad is very irritable<\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">If it\u2019s from trauma or post op \u2013 use stage 1, then recondition the limb with a good strength and conditioning plan. If there is an unstable patella causing the fat pad impingement use quads strengthening and work on proprioception to improve the patient\u2019s position of knee and reduce the irritation.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If there is a hyperextending knee causing the fat pad impingement strengthen the hamstrings and work on proprioception to improve the patient\u2019s position of knee and reduce the irritation. If there is lateral fat pad impingement, figure out what is pinching down on the lateral fat pad. If it is the lateral retinaculum and ITB \/ anteverted femoral head and poor control of femoral rotation then glutes strength and release lateral structures.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Stretching, STR and foam rolling alters the pennation angle of the vastus lateralis and makes the fibres more vertical and less able to lateralise the patella. If there is also patella-femoral pain and fat pad impingement the safe zone to work in is 20-40 degrees. Start with isometrics in this range to build strength and progress from there.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">These strategies need to be <a href=\"https:\/\/wandsworthphysiotherapy.co.uk\/service\/general-physiotherapy\/\" data-type=\"link\" data-id=\"https:\/\/wandsworthphysiotherapy.co.uk\/service\/general-physiotherapy\/\">guided by a physiotherapist<\/a> who has worked with many fat pad impingement patients.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span style=\"color: #339966;\">Ultrasound guided injections for infra-patella fat pad impingement<\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">If the above-mentioned treatment strategies are not helping then we can perform an <a href=\"https:\/\/wandsworthphysiotherapy.co.uk\/ultrasound-guided-injections\/\">ultrasound guided steroid injection into the knee joint<\/a> and the steroid will diffuse in to the fat pad and help to settle the inflammation.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><iframe title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/eLjoXw07TN0\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">At Wandsworth Physiotherapy we see self funding patients and those using <a href=\"https:\/\/www.bupa.co.uk\/health-information\/knee-pain\/infrapatellar-fat-pad-syndrome\" target=\"_blank\" rel=\"noopener\">medical insurance<\/a> who suffer from infra-patella fat pad impingement. We offer prompt assessment, ultrasound scans, diagnosis and treatment at our Wandsworth Town, Clapham Junction and Battersea Nine Elms and Vauxhall clinics.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" width=\"1024\" height=\"683\" src=\"https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2025\/04\/Wandsworth-Physio-456-1024x683.jpg\" alt=\"Infra-patellar fat pad syndrome\" class=\"wp-image-216988\" srcset=\"https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2025\/04\/Wandsworth-Physio-456-1024x683.jpg 1024w, https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2025\/04\/Wandsworth-Physio-456-300x200.jpg 300w, https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2025\/04\/Wandsworth-Physio-456-768x512.jpg 768w, https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2025\/04\/Wandsworth-Physio-456-1536x1025.jpg 1536w, https:\/\/wandsworthphysiotherapy.co.uk\/wp-content\/uploads\/2025\/04\/Wandsworth-Physio-456-2048x1366.jpg 2048w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Our Complete knee appointment available at Wandsworth Town consists or clinical assessment, ultrasound scan, strength test assessment using dynamometers and VALD force decks afterwhich we can put together a comprehensive treatment plan. <a href=\"https:\/\/wandsworthphysiotherapy.co.uk\/specialist-clinic\/knee-pain-clinic\/\">See here for more details<\/a>. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>What is the infra-patella fat pad? infra-patella fat pad impingement: The infra-patella fat pad (sometimes known as Hoffa\u2019s fat pad) is inferior to the patella and deep to the patella tendon. It\u2019s intracapsular and attached to the joint line and menisci. The superior lateral fat pad is often impinged at the lateral joint line. The [&hellip;]<\/p>\n","protected":false},"author":14,"featured_media":216533,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[344],"tags":[359,360,349,361],"class_list":["post-216748","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-sports-injury","tag-knee-pain","tag-running-injury","tag-sports-injury","tag-ultrasound-guided-injections"],"acf":[],"_links":{"self":[{"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/posts\/216748","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/users\/14"}],"replies":[{"embeddable":true,"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/comments?post=216748"}],"version-history":[{"count":0,"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/posts\/216748\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/media\/216533"}],"wp:attachment":[{"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/media?parent=216748"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/categories?post=216748"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wandsworthphysiotherapy.co.uk\/wp-json\/wp\/v2\/tags?post=216748"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}